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Coccygeal fractures are generally low-severity injuries, which nonetheless can be diagnostically challenging. Diagnosis may be delayed or missed due to coccygeal anatomy and patient/technical factors (e.g. obesity, overlying bowel gas/feces).
Given that management of coccygeal fractures is nearly always non-operative, some radiology literature suggests that x-ray evaluation for coccygodynia is a waste of resources and exposes patients to unnecessary ionizing radiation, without having measurable impact on clinical outcome 1.
Coccygeal fractures in younger adults tend to be after high-energy trauma. In elderly patients, these can represent insufficiency-type fractures 1.
Within the AO classification system, coccygeal fractures are classified as a subset of the sacrococcygeal fractures (classification A1).
Most coccygeal fractures have a transverse orientation 2. Displacement of the fracture fragment is variable.
- best demonstrated on the lateral projection 2
Treatment and prognosis
As a rule, coccygeal fracture/dislocations are treated with non-operative management (e.g. cushioning and analgesia). Significant angulation or displacement may require closed reduction, often intra-anal manipulation.
Surgery is generally reserved for open injuries requiring soft tissue debridement, or chronic symptomatic injuries. In these cases, the fractured component is generally resected (coccygectomy).